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1. When assessing a patient with joint pain, which symptom is consistent with an inflammatory process?
Answer: The symptom of tenderness is consistent with an inflammatory process.
2. A patient presents with diffuse joint pains, and you want to rule out systemic causes. Which of the
following diseases could be responsible for joint pain as a symptom?
Answer: Lupus is a systemic disease that can cause joint pain.
3. A college student comes in with joint pains after camping and mentions a tick bite. What is the most
likely cause of her joint pain?
Answer: The most likely cause of the student's joint pain is Lyme disease.
4. An elderly patient has started falling and comes in for evaluation. What part of the gait cycle is not
typically associated with the foot being arched?
Answer: The stance phase of gait does not typically involve the foot being arched.
5. A warehouse worker presents with low back pain and numbness in his leg after lifting heavy boxes.
What test should you perform to assess for a herniated disc?
Answer: You should perform a straight leg-raise test to assess for a herniated disc.
6. A construction worker comes in with mechanical low back pain that has been present intermittently
for years. What is the most likely cause of his pain?
Answer: The most likely cause of this patient's low back pain is mechanical strain due to moving
furniture over the weekend.
,A 50-year-old realtor comes to your office for evaluation of neck pain. She was in a motor vehicle
collision 2 days ago and was assessed by the emergency medical technicians on site, but she didn't think
that she needed to go to the emergency room at that time. Now, she has severe pain and stiffness in her
neck. On physical examination, you note pain and spasm over the paraspinous muscles on the left side
of the neck, and pain when you make the patient do active range of motion of the cervical spine. What is
the most likely cause of this neck pain?
Fibromyalgia
A 28-year-old graduate student comes to your clinic for evaluation of pain "all over." With further
questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, low back, and
knees. She denies swelling in her joints; she states that the pain is worse in the morning; there is no
limitation in her range of motion. On physical examination, she has several points on the muscles of the
neck, shoulders, and back that are tender to palpation; muscle strength and range of motion are normal.
Which of the following is likely the cause of her pain?
Rotator cuff tendinitis
A 68-year-old retired banker comes to your clinic for evaluation of left shoulder pain. He swims for 30
minutes daily, early in the morning. He notes a sharp, catching pain and a sensation of something
grating when he tries overhead movements of his arm. On physical examination, you note tenderness
just below the tip of the acromion in the area of the tendon insertions. The drop arm test is negative,
and there is no limitation with shoulder shrug. The patient is not holding his arm close to his side, and
there is no tenderness to palpation in the bicipital groove when the arm is at the patient's side, flexed to
90 degrees, and then supinated against resistance. Based on this description, what is the most likely
cause of his shoulder pain?
tendons
A high school soccer player "blew out his knee" when the opposing goalie's head and shoulder struck his
flexed knee while the goalie was diving for the ball. All of the following structures were involved in some
way in his injury, but which of the following is actually an extra-articular structure?
A) Synovium
B) Joint capsule
C) Juxta-articular bone
D) Tendons
Extra-articular
Ray works a physical job and notes pain when he attempts to lift his arm over his head. When you move
the shoulder passively, he has full range of motion without pain and there is no gross swelling or
tenderness. What type of joint disease does this most likely represent?
Cartilaginous
Mark is a contractor who recently injured his back. He was told he had a "bulging disc" to account for
the burning pain down his right leg and slight foot drop. The vertebral bodies of the spine involve which
type of joint?
,Temporomandibular joint
Which of the following synovial joints would be an example of a condylar joint?
A) Hip
B) Interphalangeal joints of the hand
C) Temporomandibular joint
D) Intervertebral joint
Pain that is bilateral
A 58-year-old man comes to your office complaining of bilateral back pain that now awakens him at
night. This has been steadily increasing for the past 2 months. Which one of the following is the most
reassuring in this patient with back pain?
A) Age over 50
B) Pain at night
C) Pain lasting more than 1 month or not responding to therapy
D) Pain that is bilateral
Cauda equina
Marion presents to your office with back pain associated with constipation and urinary retention. Which
of the following is most likely?
pain
Louise, a 60-year-old, complains of left knee pain associated with tenderness throughout, redness, and
warmth over the joint. Which of the following is least helpful in determining if a joint problem is
inflammatory?
A) Tenderness
B) Pain
C) Warmth
D) Redness
Articular joint pain
Pain, swelling, loss of both active and passive motion, locking, and deformity would be consistent with
which of the following?
A) Articular joint pain
B) Bursitis
C) Muscular injury
D) Nerve damage
Gonococcal arthritis
You are working in a college health clinic and seeing a young woman with a red, painful, swollen DIP
joint on the left index finger. There are also a few papules, pustules, and vesicles on reddened bases,
located on the distal extremities. This would be consistent with with what?
Delayed menarche
, An obese 55-year-old woman went through menarche at age 16 and menopause 2 years ago. She is
concerned because an aunt had severe osteoporosis. Which of the following is a risk factor for
osteoporosis?
A) Obesity
B) Late menopause
C) Having an aunt with osteoporosis
D) Delayed menarche
Rheumatoid arthritis
A 38-year-old woman comes to you and has multiple small joints involved with pain, swelling, and
stiffness. Which of the following is the most likely explanation?
A) Rheumatoid arthritis
B) Septic arthritis
C) Gout
D) Trauma
Temporomandibular joint syndrome
Mrs. Fletcher comes to your office with unilateral pain during chewing, which is chronic. She does not
have facial tenderness or tenderness of the scalp. What is the most likely cause of her pain?
2-3 weeks
A man's wife is upset because when she hugs him with her hands on his left shoulder blade, "it feels
creepy." This came on gradually after a recent severe left-sided rotator cuff tear. How long does it
usually take to develop muscular atrophy with increased prominence of the scapular spine following a
rotator cuff tear?
Acromioclavicular joint involvement
Phil comes to your office with left "shoulder pain." You find that the pain is markedly worse when his
left arm is drawn across his chest (adduction). What would you suspect?
Lateral epicondylitis (tennis elbow)
Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She presents with elbow
pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against resistance
when her palms face the floor. What condition does she have?
scaphoid fx
A high school football player injured his wrist in a game. He is tender between the two tendons at the
base of the thumb. Which of the following should be considered?
median nerve
Mrs. Fletcher complains of numbness of her right hand. On examination, sensation of the volar aspect of
the web of the thumb and index finger and the pulp of the middle finger are normal. The pulp of the
index finger has decreased sensation. Which of the following is affected?
1. When assessing a patient with joint pain, which symptom is consistent with an inflammatory process?
Answer: The symptom of tenderness is consistent with an inflammatory process.
2. A patient presents with diffuse joint pains, and you want to rule out systemic causes. Which of the
following diseases could be responsible for joint pain as a symptom?
Answer: Lupus is a systemic disease that can cause joint pain.
3. A college student comes in with joint pains after camping and mentions a tick bite. What is the most
likely cause of her joint pain?
Answer: The most likely cause of the student's joint pain is Lyme disease.
4. An elderly patient has started falling and comes in for evaluation. What part of the gait cycle is not
typically associated with the foot being arched?
Answer: The stance phase of gait does not typically involve the foot being arched.
5. A warehouse worker presents with low back pain and numbness in his leg after lifting heavy boxes.
What test should you perform to assess for a herniated disc?
Answer: You should perform a straight leg-raise test to assess for a herniated disc.
6. A construction worker comes in with mechanical low back pain that has been present intermittently
for years. What is the most likely cause of his pain?
Answer: The most likely cause of this patient's low back pain is mechanical strain due to moving
furniture over the weekend.
,A 50-year-old realtor comes to your office for evaluation of neck pain. She was in a motor vehicle
collision 2 days ago and was assessed by the emergency medical technicians on site, but she didn't think
that she needed to go to the emergency room at that time. Now, she has severe pain and stiffness in her
neck. On physical examination, you note pain and spasm over the paraspinous muscles on the left side
of the neck, and pain when you make the patient do active range of motion of the cervical spine. What is
the most likely cause of this neck pain?
Fibromyalgia
A 28-year-old graduate student comes to your clinic for evaluation of pain "all over." With further
questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, low back, and
knees. She denies swelling in her joints; she states that the pain is worse in the morning; there is no
limitation in her range of motion. On physical examination, she has several points on the muscles of the
neck, shoulders, and back that are tender to palpation; muscle strength and range of motion are normal.
Which of the following is likely the cause of her pain?
Rotator cuff tendinitis
A 68-year-old retired banker comes to your clinic for evaluation of left shoulder pain. He swims for 30
minutes daily, early in the morning. He notes a sharp, catching pain and a sensation of something
grating when he tries overhead movements of his arm. On physical examination, you note tenderness
just below the tip of the acromion in the area of the tendon insertions. The drop arm test is negative,
and there is no limitation with shoulder shrug. The patient is not holding his arm close to his side, and
there is no tenderness to palpation in the bicipital groove when the arm is at the patient's side, flexed to
90 degrees, and then supinated against resistance. Based on this description, what is the most likely
cause of his shoulder pain?
tendons
A high school soccer player "blew out his knee" when the opposing goalie's head and shoulder struck his
flexed knee while the goalie was diving for the ball. All of the following structures were involved in some
way in his injury, but which of the following is actually an extra-articular structure?
A) Synovium
B) Joint capsule
C) Juxta-articular bone
D) Tendons
Extra-articular
Ray works a physical job and notes pain when he attempts to lift his arm over his head. When you move
the shoulder passively, he has full range of motion without pain and there is no gross swelling or
tenderness. What type of joint disease does this most likely represent?
Cartilaginous
Mark is a contractor who recently injured his back. He was told he had a "bulging disc" to account for
the burning pain down his right leg and slight foot drop. The vertebral bodies of the spine involve which
type of joint?
,Temporomandibular joint
Which of the following synovial joints would be an example of a condylar joint?
A) Hip
B) Interphalangeal joints of the hand
C) Temporomandibular joint
D) Intervertebral joint
Pain that is bilateral
A 58-year-old man comes to your office complaining of bilateral back pain that now awakens him at
night. This has been steadily increasing for the past 2 months. Which one of the following is the most
reassuring in this patient with back pain?
A) Age over 50
B) Pain at night
C) Pain lasting more than 1 month or not responding to therapy
D) Pain that is bilateral
Cauda equina
Marion presents to your office with back pain associated with constipation and urinary retention. Which
of the following is most likely?
pain
Louise, a 60-year-old, complains of left knee pain associated with tenderness throughout, redness, and
warmth over the joint. Which of the following is least helpful in determining if a joint problem is
inflammatory?
A) Tenderness
B) Pain
C) Warmth
D) Redness
Articular joint pain
Pain, swelling, loss of both active and passive motion, locking, and deformity would be consistent with
which of the following?
A) Articular joint pain
B) Bursitis
C) Muscular injury
D) Nerve damage
Gonococcal arthritis
You are working in a college health clinic and seeing a young woman with a red, painful, swollen DIP
joint on the left index finger. There are also a few papules, pustules, and vesicles on reddened bases,
located on the distal extremities. This would be consistent with with what?
Delayed menarche
, An obese 55-year-old woman went through menarche at age 16 and menopause 2 years ago. She is
concerned because an aunt had severe osteoporosis. Which of the following is a risk factor for
osteoporosis?
A) Obesity
B) Late menopause
C) Having an aunt with osteoporosis
D) Delayed menarche
Rheumatoid arthritis
A 38-year-old woman comes to you and has multiple small joints involved with pain, swelling, and
stiffness. Which of the following is the most likely explanation?
A) Rheumatoid arthritis
B) Septic arthritis
C) Gout
D) Trauma
Temporomandibular joint syndrome
Mrs. Fletcher comes to your office with unilateral pain during chewing, which is chronic. She does not
have facial tenderness or tenderness of the scalp. What is the most likely cause of her pain?
2-3 weeks
A man's wife is upset because when she hugs him with her hands on his left shoulder blade, "it feels
creepy." This came on gradually after a recent severe left-sided rotator cuff tear. How long does it
usually take to develop muscular atrophy with increased prominence of the scapular spine following a
rotator cuff tear?
Acromioclavicular joint involvement
Phil comes to your office with left "shoulder pain." You find that the pain is markedly worse when his
left arm is drawn across his chest (adduction). What would you suspect?
Lateral epicondylitis (tennis elbow)
Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She presents with elbow
pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against resistance
when her palms face the floor. What condition does she have?
scaphoid fx
A high school football player injured his wrist in a game. He is tender between the two tendons at the
base of the thumb. Which of the following should be considered?
median nerve
Mrs. Fletcher complains of numbness of her right hand. On examination, sensation of the volar aspect of
the web of the thumb and index finger and the pulp of the middle finger are normal. The pulp of the
index finger has decreased sensation. Which of the following is affected?
